Do unto others: what we do about elder abuse will be our legacy
Authors: Fiona Ecarnot
Journal: The Lancet Healthy Longevity (2022)

How many people over 60 do you know? If you know six or eight, then chances are at least one of them has been a victim of elder abuse. It is estimated that around 15% of community-dwelling older people (>60 years) globally are affected by elder abuse.1Yon Y Mikton CR Gassoumis ZD Wilber KH Elder abuse prevalence in community settings: a systematic review and meta-analysis.Lancet Glob Health. 2017; 5: e147-e156Summary Full Text Full Text PDF PubMed Scopus (335) Google Scholar Alarmingly, in the institutional setting, among older people who are more vulnerable and therefore merit more attention and care, the prevalence of elder abuse is reportedly even higher, ranging from 33·4% for psychological abuse to more than 64% of staff in nursing homes admitting to having perpetrated elder abuse or neglect within the previous year.2Yon Y Ramiro-Gonzalez M Mikton CR Huber M Sethi D The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis.Eur J Public Health. 2019; 29: 58-67Crossref PubMed Scopus (102) Google Scholar Is this how we want to treat our elders? The COVID-19 pandemic has shone a spotlight on the treatment of older people in many societies, with ensuing reflection about how and where older people age, how they live their (potentially not so) golden years, and how they die. What elevates elder abuse above the myriad other worthy causes as something that merits special attention, particularly from governments and policy makers? In today's world, there are innumerable issues competing for space in the political arena, with a view to changing frameworks or achieving funding. However, elder abuse is not just a public health issue—it extends well beyond the boundaries of medicine. Elder abuse is an issue that involves human rights, justice, the law, the economy, and quite simply, who we are as humans. Two quotes from the Indian politician and activist Mahatma Gandhi spring to mind: first, “the true measure of any society can be found in how it treats its most vulnerable members,” and second, “the future depends on what we do in the present.” Both quotes need to be taken to heart regarding elder abuse. WHO defines elder abuse as a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.3WHOElder abuse.https://www.who.int/news-room/fact-sheets/detail/elder-abuseDate: 2021Date accessed: June 7, 2022Google Scholar The scope of this definition encompasses physical, psychological, sexual, and economic abuse, as well as neglect. Elder abuse can be perpetrated by close family, relatives, health-care staff, or strangers, and it has devastating physical and psychological consequences. The number of older people in society is rising at an unprecedented rate and, accordingly, so is the pool of potential victims of elder abuse. The looming costs of this plague are immense,4Stankunas M Avery M Lindert J et al.Abuse in the elderly—cost driver in a health care system?.Popul Health Manag. 2016; 19: 224-225Crossref PubMed Scopus (1) Google Scholar so it is urgent to take action to change behaviours towards older people. One would think that the magnitude of the problem would prompt more decisive action, but this has not been the case. In The Lancet Healthy Longevity, Christopher Mikton and colleagues analyse the factors that account for the low priority of elder abuse on political agendas worldwide.5Mikton C Campo-Tena L Yon Y Beaulieu M Shawar YR Factors shaping the global political priority of addressing elder abuse: a qualitative policy analysis.Lancet Healthy Longev. 2022; (published online July 8.)https://doi.org/10.1016/S2666-7568(22)00143-X/Summary Full Text Full Text PDF Scopus (3) Google Scholar They point to the intractable nature of the problem as a first major barrier to wider awareness. Indeed, elder abuse is a complex, multifaceted issue that is hard to measure accurately. The forms of elder abuse are so numerous, heterogeneous, and even insidious, that no single indicator can adequately encompass all the outcomes, and there is no single metric that can satisfactorily be used as a target for interventions to improve behaviours. Elder abuse is also largely underreported;6Pillemer K Burnes D Riffin C Lachs MS Elder abuse: Global situation, risk factors, and prevention strategies.Gerontologist. 2016; 56: S194-S205Crossref PubMed Scopus (288) Google Scholar indeed, it might even be unrecognised. Some older people might not be aware that the treatment they are receiving constitutes elder abuse or neglect, and carers engaging in paternalistic behaviours that override the rights of elders might genuinely believe that they are acting beneficently and in the older person's best interests. This view should not be construed as an attempt to disculpate the perpetrators of elder abuse—regardless of whether they are aware that their actions qualify as elder abuse, the behaviours remain reprehensible. Further barriers preventing elder abuse from achieving the attention it deserves include the policy environment. The current UN Decade of Health Ageing provides a prolonged opportunity to capitalise on the public awareness and media presence of elder abuse in order to make meaningful progress and instigate lasting change. Cohesion among all groups working to fight elder abuse across disciplines is a must if we are to make any progress in eliminating this problem. We need to call out the problem and take action to change behaviours and attitudes across the full spectrum of fields affected by elder abuse, not only in hospitals, but also in the community and the institutional setting. If no action is taken, one in six of us is going to be affected by elder abuse when we reach 60. I declare no competing interests. Factors shaping the global political priority of addressing elder abuse: a qualitative policy analysisAround 25 years ago, elder abuse started to register on the global agenda. Since then, the global priority for prevention of elder abuse has barely increased. This study identifies several inter-related factors that account for the issue's low priority and opportunities for overcoming these challenges. Chief among these opportunities is the UN Decade of Healthy Ageing 2021–2030, a unique 10-year-long policy window to increase the political priority of the prevention of elder abuse. Full-Text PDF Open Access